Counseling Skills | Addiction Counselor Exam & NCMHCE Review

Welcome to the Addiction Counselor Exam Review. This presentation is part of the Addiction Counselor Certification training. Go to. Learn more about our specialty certificates structure starting at $149. Hi everybody and welcome to today's presentation of the Addiction Counselor Exam Review. Today we're going to be talking about counseling skills. Over the next little while, we're going to hit the highlights of the purpose and function of counseling, identifying skills a counselor needs. We're going to identify necessary attitudes for counselors and explore how to develop a therapeutic alliance and motivation. Now, each one of these things is its own course in and of itself, but for the review, we're just going to hit the highlights. To learn more about any of these areas, go to our YouTube channel, allce.com YouTube and you can search through more than 200 videos that we have on various topics related to counseling and motivation. So what do we do in counseling? Well, what we want to do is develop a therapeutic relationship with clients, families, and significant others to facilitate transition into the recovery process. So what does that mean? That means we need to develop a working alliance with them. We need to be able to connect with them in order to help them move towards their goal of recovery, however they define it. And we don't want to just focus on the client because the client doesn't exist in isolation. We want to focus on the client and their support system, and that's their family, however they define family and their significant others, their friends, anybody they spend a lot of time with. We want to look at those relationships and how we can help clients use those relationships to facilitate their recovery process. We want to provide information to clients and their families and significant others regarding the structure, expectations, and purpose of counseling so they have an idea where we're coming from. But at the same time, we want to elicit this information from the client. What do you want counseling to look like? What are your expectations for counseling, and what do you hope to get out of this? That way we understand where the client is coming from and we can work toward mutually agreeable goals. We also want to continually reevaluate the client's safety in terms of their physical environment, but also suicidal or homicidal ideation and relapse potential. We want to look at any need for crisis intervention. And you know, this can be a mental health thing. For crisis intervention. It also can be detoxification if they go out and binge for a while or start engaging in other highly risky behaviors that could indicate that they may need to have some professional intervention. We want to apply evidence based Practices to facilitate progress. We don't just want to pull stuff out of the air and go, oh, this sounds like it'd be good. We want to look at what research is out there and what techniques are out there that are supposed to be the most effective with this particular type of client, with this particular background, and then apply those evidence based practices. Cognitive behavioral is one of those evidence based practices. Dialectical behavioral, motivational interviewing, motivational enhancement, all of those are evidence based practices. So we're not talking about anything that's like way out in left field here, but we also want to make sure that we're using practices that are culturally responsive to the client. We document counseling activity in progress. You know, if it doesn't get documented, it didn't actually happen. At least that's what they say. Now if you end up, you know, doing something that you regret, please don't, but. And then you don't write it down, that doesn't absolve you. But if you, in order to document, if a client says that you weren't providing certain services or you abandoned them or whatever, if you have documentation that you saw the client, then it happened. If you don't have that documentation, even if you did see the client, then it didn't happen. If you bill for something and you don't have documentation, it didn't happen. So you need to make sure you document for billing for legal reasons, as well as to let the client be able to go back over the record and look and see their progress. Because progress can be really incremental. But every single drop in a bucket eventually will fill up that bucket. We want to provide information on issues of identity, ethnic background, age, etc. As they influence behavior prevention and recovery. Again, that's a lot of stuff in one sentence. We need to be culturally responsive. But we also want clients to understand how their personal identity and who they are influence their behavior, influence their choices, influence their recovery trajectory as opposed to somebody else. Because every client has their own unique individual recovery trajectory and prevention and relapse prevention is going to be different for each individual client because each client has their own triggers and their own vulnerabilities that may be unique. So we need to look at what does Jane need in order to facilitate her recovery and what does Tom need and et cetera. But we don't want to just say in order to maintain recovery, you need to do X, Y and Z for everybody. That's not exactly how it works. So we do need to make sure we use an individualized, culturally responsive approach. And we provide information about addiction and related health and psychosocial consequences to the client. And a lot of times this comes during the assessment. We provide them information about what addiction is and destigmatize the diagnosis and help them understand maybe where it came from. But also help them identify any health and psychosocial consequences, like relationship issues, legal issues, employment issues, financial issues, yada yada, that could be caused by this addiction or or worsened by this addiction. Because that's where we're going to start identifying some motivations. I do want you to remember though, that every behavior has a purpose. If somebody is engaged in an addictive behavior, there were some positive consequences. Let me say that again. There were some positive consequences. So psychosocial consequences, positive ones may have been that they found a group of people who didn't seem to ever abandon them. Now, those people may not have been good for them, those people may have used them, but those people never seem to abandon them. Health consequences. Maybe it helped them not feel so much anxiety and they were self medicating something. Okay, you know, there are better ways, there are healthier ways to achieve those same goals. But we do need to recognize that there were positive as well as negative consequences of use. Counseling is a collaborative professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals. So counseling isn't always just about relapse prevention or just about addiction. We have to get broader than that because people are not just about addiction. People are people first, people with addictions. They are not just addicts, they are people with addictions. So, okay, that means we need to be able to educate them about mental health issues and help them see how they can improve their mental health and improve their physical wellness. And a lot of times, in order to have an optimal quality of life, people want to enhance their career and maybe their education. So we need to help them figure out, where do I go to figure out how to do this? We don't have all these skills, but we can make referrals. Competence is built on understanding various models of treatment and ability to implement appropriate evidence based practices with individuals, families and significant others. So as we are growing as clinicians, we're developing our confidence. And you may have come out of graduate school or you may come out of, come out of your training and you have competence in this little narrow slice of the pie in terms of a particular model of treatment and an ability to interact with individuals, families and significant others as you do your continuing education and as you go through your career you're going to learn more tools, more evidence based practices, so you're going to get progressively bigger slices of the pie. You know, when I first started, I got out of graduate school and I knew humanistic therapy, Rogerian based counseling. Now that really is not super effective with addictions, but it's good for developing rapport. So I was good there. The next thing I learned was motivational interviewing. And once I became confident, confident and competent at motivational interviewing, my competence increased some more. And then I moved on and I worked on developing skills in cognitive, behavioral and then dialectical behavior. And you see how it goes. So now I have multiple evidence based practices in which I am competent that I can choose to use from my toolbox. When working with clients, it's not something that happens overnight. This is something that you're going to work on over your career. If you are working with a client and your particular approach is not seeming to work, but you don't have confidence in a lot of other areas, that's when you seek consultation. That's when you go find your supervisor or somebody who's got more experience and go, okay, I'm stuck here. I need some help working with this client. And that person can probably start to guide you along the way to identify what kinds of skills and tools you need to learn in order to best help this client. As counselors, we facilitate self exploration, self disclosure, problem solving, and behavioral change. Notice I said we facilitate it. We don't necessarily do it. You know, we want to help clients look inside themselves. We want to help them feel free and feel able to disclose stuff that they've been holding inside. We want to facilitate their problem solving. We don't do it for them. Ideally, we want to use Socratic questioning to help them figure out, okay, you know, I've got this problem here and I want to get to this solution here. Now how do I do that? And we can help them brainstorm, we can help them learn problem solving. If we go in and we just tell them how to do it, they're not going to learn anything. They're not going to be able to solve the next problem when it comes up. You know that old adage, give a man a fish, he eats for a day, teach a man to fish, he eats for a lifetime. So we do want to facilitate these skills and clients, we want them clients to explore and enhance their own motivation. So they need to explore what are the benefits and drawbacks. And in tip 35 from SAMHSA, motivational interviewing, you'll see a quadrant model for a decisional balance exercise. And they need to look at the benefits and the drawbacks of staying the same. Because there are benefits to staying the same. There are drawbacks too. And when you look at those benefits of staying the same, you know, you look at them together and the client's going, yeah, you know, there are some positives to this. We can help them look at those things and say, okay, those positives. How else could you achieve that same thing without the use of alcohol or drugs? So how else could you feel less anxious in social situations without the use of alcohol? You know, let's look at some other things you can do besides drinking in order to reduce your inhibitions. So we want to help them take away some of the benefits, you know, find other ways to get those same benefits. And then they need to look at the benefits and drawbacks of change, because obviously there's benefits to change. They're going to be healthier, hopefully happier, yada, yada. But there are drawbacks to change. Change is scary, change is hard. Change. There's no guarantee it's going to stick. So we want to look at all those apprehensions and concerns they have about change and again, address each one of them to take away as many of those drawbacks to change as possible. So that increases their motivation. We help clients set appropriate treatment goals, understand structure, expectations, purpose and limitations of the counseling process. You know, we can only lead them to water, we can't force them to drink, so to speak. So they need to understand what the structure of your program looks like, what they've got. You know, if they're expecting to have once a week counseling and then be able to text you whenever they want between sessions, you know, if that's the way your program works, then great. But if it's not, they need to know that up front that they're going to have once a week with you and then they have to go to meetings or something the other six days a week. And we're going to help them mobilize resources to resolve problems and modify attitudes. If they are not in a job they're happy with, we can help them identify resources such as the local one stop where they can go and get career counseling and help finding another job. If they need additional education, you know, one stop can help them with that. If they need medical assistance, we can refer them out to programs to do that. And we want to respond to crisis situations by identifying and practicing ways to avoid and cope with high risk situations. And when I'm talking about crisis here, I'M talking about addiction crisis where they are just really tempted to relapse. They are struggling to stay clean and sober. So we want to talk about, okay, you're here right now, you haven't used or, you know, you used once, but you're back. That's great. Let's figure out ways to avoid and cope with these high risk situations in the future. What can you do starting right now so you're safer in terms of your relapse potential. In order to make all these things happen, we need to have a good therapeutic alliance. And the strength of the therapeutic alliance depends on the facilitative qualities of the counselor. So how easy are you to talk to? And the strategies used to create a positive environment for exploration and change? So are you easy to talk to? Does it feel like a safe environment? Are you using effective strategies for that client? And terms of their age, their cognitive development, their culture, their learning style, all of those things are important to be aware of. Facilitative qualities that we need to work on. Developing empathy. Now, most people who get into counseling are pretty good with empathy, but you do need to practice the difference between empathy and sympathy. Empathy is when you've got somebody down in a well and it's cold and it's dark. Empathy, you strap on rappelling gear and you go down there with them. So you're experiencing, to a certain extent, the same thing they're experiencing now. You can pull the rope and you can get out of there. They're stuck for a while, but you can share in what's going on. Sympathy is when you just stand at the top of the well and look down and go, oh, sucks to be down there. And you're sympathetic to their situation, but you're not really experiencing it similarly to them. So empathy, you're really trying to get in their shoes and understand what's going on. We need to be genuine. Sometimes we're not going to agree with clients, and sometimes, more often than not, we're not going to agree with clients and that's okay. But we don't want to lie to them. So if they ask our opinion, we need to tactfully give our opinion. We do need to be genuine with them. If we feel like they are, you know, at risk of relapse. If we feel like they've got a blind spot somewhere, we may want to bring that up and put that out on the table. Just being genuine and honest, not criticizing, not condescending, but genuinely caring. We need to be respectful. We do need to use a little Bit of self disclosure. Now, that doesn't mean telling them your whole life story. Please don't. Self disclosure is appropriate as long as it is on point and it helps the client move forward. So, you know, if the client went through a trauma and you went through a similar trauma, it doesn't mean you have to share your trauma too. You know, that doesn't necessarily have to happen. But if the client is stuck and saying, you know, I don't think you understand, or you just don't understand, you might be able to share a little bit. Don't go into all the details, but you can say, you know, I went through a similar situation when I was younger. Or if they're struggling with parenting issues or their kids are angry at them or something, you can empathize and say, yeah, I've got teenagers too. That's. It is a really tough age. So they feel like you're a little bit more human. You've got a few more dimensions than just being somebody sitting in that chair. But self disclosure should be minimal, and it should never, never, never exceed what the client is disclosing. So they give some. You may give a little bit back because that makes it safer. If they feel like you're a little bit more open and vulnerable, they're going to possibly be more willing to be open and vulnerable. Warmth. We need to be warm. We need to be inviting. We need to be immediate with a focus on the here and now. So what's going on with you right now? How can I help you improve the next moment? Now, depending on your theoretical approach, you may be psychodynamic and looking back towards, you know, what happened in your childhood or whatever, and that's okay. But we're looking at what happened in your childhood in terms of how is this, whatever that is impacting you in the present. And if it's impacting you in the present, maybe you were abused in your childhood and that's still impacting you in the present. Okay, so we need to go back there and we need to resolve that issue, or we need to resolve how it's impacting you in the present, depending on your approach. But the clients are not generally interested in doing a walk along memory lane to go back and look at every hiccup in their past unless it is relevant to helping them feel better now. We need to be concrete, identifying specific problems and interventions, which is one of the places where your cognitive approaches come in really handy, because they are very concrete, you know, helping you feel better. That's way too vague, and that Wouldn't make a good treatment plan anyway. But we want to identify specific problems. Sleeping. Maybe the person has insomnia or is sleeping too much. Maybe the person doesn't have enough energy, maybe they are depressed. But in order to identify a specific problem, we need to know what depressed looks like for them. And if you remember from the treatment planning presentation, you want to have, as evidenced by the client, reports that he is depressed, as evidenced by and then write down his symptoms, that's the problem statement the client identifies. You know, will know when he's no longer depressed because. Or as evidenced by, and he will identify what it'll look like when he's not depressed anymore. So we want to identify specific problems and goals, and then we can identify specific interventions and help the client see how those interventions tie to helping him achieve his goal. We don't want to just throw out these interventions like, okay, you're depressed, so I think you should start working out 30 minutes every day. The client may be like, why? You know, how does that help me sleep any better? So we want to make sure that we connect all the dots for the client so they can see the purpose underlying each intervention. And we need to be culturally sensitive and responsive. Some clients are going to be from high context cultures and some are going to be from low context cultures. Some clients are going to have a much different view of what addiction or mental health issues mean about them and about their family than others. So we do need to be very aware of any cultural issues. Components of the therapeutic alliance include the bond between the therapist and the client, which is characterized by warmth, genuineness, and respect, and consensus between the counselor and the client regarding treatment approaches and the goals of treatment. The easiest way to really start forging this therapeutic alliance is to hear the client not take them and say, okay, the goals of this program are X, Y and Z. No treatment involves the goals of the client. So, you know, I've had clients come in before who were on probation and they really had no intention of stopping using forever. That was not their thing. Their goal was to get off probation. And in order to do that, they had to stay clean and sober and they had to complete the program. So they'd come in and we would work together and I would say, okay, your goal is to get off papers. In order to do that, you've got to complete this program. So let me tell you what you got to do to complete the program, and then you can be done with me, you can be off probation and you can go back to doing whatever you want. And that's how we start forming a therapeutic alliance. I'm not lecturing him. I'm not telling them. Well, you have to. You know, you really need to stop using because it's bad for you. That's the easiest way to get clients to shut down. I want to hear what their goals are, and I want to make the treatment plan help them achieve their goals. I want to identify treatment approaches that work for that client. Some clients are really into talking about feelings. Others would rather pull off their toenails than talk about feelings. Some clients love group. Other clients, not so much. I had one client who came in, sat down, and the first thing she said to me, before we even started the assessment was, I'm not going to any of those meetings. I said, okay, hi, you know, my name is. And we got started, and I told her, you know, what we're going to do is figure out what types of services might be helpful for you, and then we'll figure out which ones work for you. So I'm less interested in what you're not going to do. I want to know what you're going to do instead. And she got very quiet after that for a few minutes because nobody had ever talked to her like that. They'd always tried to push her into the treatment program goals instead of goals for her. The primary responsibility for developing and maintaining the therapeutic alliance rests with the counselor. So if you don't feel like you're making a good therapeutic alliance, you need to go back and check those. Warmth, empathy, genuine, all that stuff. There are times where the client may have some countertransference issues towards you, and it's not going to be a good relationship. And you may consider transfer at that point, but those are rare. I think I had that twice in 20 years. So generally, you can figure out a way to forge a mutually agreeable relationship. 80% of positive outcomes are due to therapeutic alliance. And this is important. I had somebody in one of the groups I'm a member of the other day talking about how overwhelmed she felt because she got out of school. And as soon as she started practicing, she started realizing how much she really didn't know. And she felt overwhelmed and like she'd never be able to learn of the tools and techniques she needed to help her clients. And, you know, I pointed out that you came out of school so you have the license or whatever, but 80% of what happens in that treatment room is due to your therapeutic alliance. It's due to your personal characteristics, your warmth, your genuineness, your empathy skills. And tools, you know, that's 20% of it. So most of what you need, you already have. Everything else is just icing on the cake. And it seemed to help her feel a little bit better. But I do want you to remember that going into a situation, once you get certified or licensed, there is a lot left to learn. I mean, I have been doing this for 20 years, and every day I learn something new, which is one of the reasons I love teaching, because I get to learn something new every day. But recognize that and recognize the fact that there's always going to be new stuff to learn. But 80% of what you need, you've already got inside you. The therapeutic alliance must be continually monitored and nurtured to prevent premature discharge and enhanced treatment effectiveness. It's easy, especially if you're working in a clinic or something, to get busy, to get tied up with, you know, your mind tied up with different things, and to not be as focused with the client. It's easy for a client's motivation to start to wane a little bit, and that's when we need to jump in there. We need to be mindful, and we need to be present in every session with clients, and we need to notice if their motivation or their enthusiasm is starting to wane. And check and see. Is it the therapeutic alliance? Are we starting to reach an impasse for some reason, or am I needing to act as more of a cheerleader right now? But it's up to us to identify the fact that, yeah, we're starting to grow apart. Let's see if we can get this thing going again. And we need to adapt the relationship to several patient characteristics, not just their diagnosis. So if they've got adhd, for example, they may not be able to sit down and focus for an hour at a time. If they're just out of detox, they're certainly not going to be able to sit down and focus for an hour at a time. So we need to attend to the individual characteristics of the client at that point in time and address treatment accordingly. So what are some skills we need? We need to be able to engage the clients. You know, walk in there, create warmth and genuineness, start talking. And I always suggest to clients or counselors, when they first go into a room, they may have a stack of assessment papers an inch thick. I know we used to, or, you know, the equivalent on the computer. But spend the first five minutes making direct eye contact with the client and talking to them and getting to know them. Five minutes. That's all it takes That'll give you some information that you can put into your assessment. But that makes the client feel more engaged and more like a person instead of just a number. And we want to engage them. I want them to know from the outset that they're the expert on them and I want to help them, but I need to know what they want, what are they looking for? And they're going to guide me in the treatment planning process. Then we develop an individualized treatment and recovery plans. We describe and negotiate across the continuum of care. So we do our assessment. We may determine this person needs to be in partial hospitalization php and we can explain what that means to them. And they may say, great, sign me up. Or they may say, you know what, that sounds good. But I don't know that I can stay clean in the evenings because I go home and everybody where I live is using or I'm homeless or whatever, you know, so they may want to bump up to residential or they may think that that's too much because they've got to continue to work and they've got kids at home and whatever. So they want to do IO, evening, IOP or something else. So we can talk about the continuum of care. We'll talk about what they score out on the asam, but then we're going to talk about what their other options are to figure out what's going to work best for them. We adapt counseling strategies to meet clients particular needs. We apply culturally and linguistically responsive communication styles, including nonjudgmental, respectful acceptance of cultural, behavioral and value differences. So it's important to know what the values and cultural edicts are of the clients that you're working with. And if you don't know, ask. You know, if you're working with a client who is atheist and you're Catholic and you don't understand their philosophical approach, ask them, you know, how would you explain this? Or in what way can this make sense in the way you conceptualize the world? Elicit the client's perspective on their progress. And I suggest you do this at least once a week, but preferably after every session. Have them write up a little thing or when you're doing your notes at the end, ask them, how do you feel you're progressing? Do you feel like you're stuck? Do you feel like you're going backwards? Or do you feel like you're still moving forward, even if it's just slowly? Get an idea from them. Remember to maintain contact with referral sources. So if you refer them out to workplace one Stop. If you refer them out to a physician or a dentist, make sure to continue with those referrals and check in. Make sure the clients made their appointment and getting the services that they need. Document all relevant aspects of treatment clearly and concisely. Don't write a dissertation, please. It looks pretty, but it takes too much time. There are a lot of things you can do with creating checklists that clients can fill out that give them, that they can give to you, that you help to, that you use to create your notes and anything else. And auditors really like to see stuff in clients handwriting in the chart. So you know it's a win win. If you give them a checklist at the end, they're not going to want to write a dissertation. But if you give them a checklist, then they can work on that and provide education regarding how to change risk behaviors, adopt protective, healthy practices and make appropriate use of service systems. This can be something as easy as riding the bus. I worked with several clients who had never ridden the bus before and they lost their license so now they had to ride the bus. So one of the things we did one day was go out as a group and learn how to ride the bus. That helped them feel better about the process so they were able to go out and start looking for employment. We help clients and help clients clarify what's going on. So if they're feeling icky that day, well, icky doesn't really help me here. So tell me what's changed or you know, what you're feeling icky about. Tell me what your thoughts are. Help them try to explore and figure out what's causing them to feel icky that day. And there may not be much to it. You know, it could be they didn't get enough sleep that night and their neurotransmitters are just out of whack. But we want to look at that. We want to look and say what changed today from yesterday? That suddenly you're feeling icky. We want to be able to clearly listen and listen without judgment and without immediately trying to correct the client. We don't want to jump in and fix it. Well, we want to. A lot of times we do want to just jump in and say, okay sweetie, you just need to do this. But that is not helpful to the client. We need to hear what's going on and then we need to figure out how to ask the right questions to get them to figure out what the best solution would be. We need to be able to reflect, summarize and repeat what the client said that good old active listening. We need to be able to ask open ended questions. Remember, closed ended questions are ones that can be answered with a yes or a no. So are you happy? Today is a closed ended question. How do you feel? Today is a little bit more open because they may say happy or whatever. So you want to ask questions that cannot be answered with just a yes or a no. Use effective body language. And the acronym that I learned in graduate school was solar. You want to be sitting, you want to have your posture open, leaning slightly forward, good eye contact, being responsive to the client, giving minimal encouragers here and there. And watch for nonverbal cues. If the client suddenly closes off or turns partially away from you, that's a clue. If their voice starts to rattle or they start to get really shaky, could mean they're getting ready to tell you about something that's really traumatic to them. So be aware of those nonverbal cues. And if you notice that they're getting nervous or uncomfortable, identify it. Say, it seems like you're, you're getting uncomfortable. I'm wondering, you know, what's going on or if there's a way I can help you. We need to appreciate the strengths based approaches which emphasize client autonomy and skills development. So instead of focusing on the stuff they don't have, we want to focus on what they do have. So when you've stayed clean for four hours, what were you doing differently? When you've stayed clean for four weeks, what was different? And those are the strengths. What did you do to help you stay clean for those four hours, those four weeks? What resources and strengths do you have in your life right now? You know, your job, your friends, your family, your finances, whatever it is. Let's start looking at what resources you have that you can pull on. We do want to respect the client's right for self determination. Just because you may think that abstinence is the only treatment goal, that may not be what the client sees. So we do need to respect their right to choose treatment or to choose their treatment goals, which may not be exactly what you would prefer. We need to appreciate the roles of the significant others and the difficulties that families and significant others face in seeking help. They try to get their loved one into treatment and their loved one may go and then come, leave against medical advice or go for a while and complete treatment, but then still be struggling. They may face financial difficulties trying to get the significant other in treatment. They may face long waiting lists. Oh boy, long waiting lists trying to get their significant other in treatment. So there's a lot of frustration that family members may face in trying to help the individual get into treatment. We need to appreciate cultural differences and be willing to be flexible. And you know, there's a certain amount of flexibility that you need to have and then there's taking it too far. But you do need to be willing to be flexible with your treatment approach in order to individualize it to that particular client. Clients with substance abuse issues and severe and persistent mental illness are going to need a much different treatment program than someone with substance abuse and mild mood issues. So setting the expectations. We need to generate curiosity and engagement by being honest and open and setting the frame and expectations for treatment. Make them look forward to recovery, make them see, wow, you know, if I can get clean and sober and happy, this is what life can look like. So we want to elicit client expectations. You know, what outcomes do they expect? What do they want? You know, if they reached recovery, what would it look like? What proportion of the clients report their issues improve at this level of treatment? So, you know, if a client comes in and you know, has been using for 15 years and they want to go into IOP, you know, what proportion of clients who have been long term users improve in iop? So let's be honest with them about what they can expect. Be honest with them about what treatment will involve. You know, and some people think back to the old movies like One Flew over the Cuckoo's Nest, where people are sitting around in gowns and in a little circle somewhere and they're like, no, I'm not doing that. So you want to help them understand what types of activities and what types of things they're going to do in your treatment program. Help them understand the rules and responsibilities, their rights, and what specific outcomes that they can expect in their course of treatment. If you've got a client who's been using for 15 years and you've only got in for 30 days, we're not going to promise that he's going to be clean, sober and elated when he gets out and he's going to stay that way forever. You know, 30 days, especially for a long term user, is really that extended protracted withdrawal period. So we're getting him, so he's really ready to start the hard work. So we want to make sure that the client understands exactly where he's going to be at when he discharges. When we're working with clients, we need to remember that treatment is a process of intentional change. We can't just change them, we can't go in there and say, I want you to be this way. The clients have to have the intention, the desire, the motivation to change. They have to want to do it. Motivational interviewing uses specific techniques that engender engagement, empowerment. It gets them to buy in and go, okay, this is cool, I can do this. And it helps them move forward. Motivational interviewing has been more effective than intervention in many, many instances. So it's important to recognize that, you know, we want to go in and when we're talking to the client during that assessment, we want to do it from the perspective of constantly engaging them, getting them excited about the possibility of being happy and healthy instead of sick and tired, and empower them. So they walk out of that session thinking, I can do this. Ambivalence about change is normal and creates a significant obstacle to the recovery process. A lot of people are ambivalent. Change is hard, and change upsets the apple cart. And a lot of people change, and then they relapse, and that's scary and disappointing and frustrating and, you know, lots of other words. So, okay, let's acknowledge that instead of pretending it doesn't exist and say, you know, I hear there are some benefits to use and there are some reasons why you might not want to give it up and you might feel like you're going to miss it when you don't, when you're not using anymore. I get that. So let's talk about those things. Ambivalence can be resolved by working with intrinsic motivations and values. So we do that decisional balance exercise, and we say, ok, tell me about the values that you hold. What kind of a person are you? All right, how does recovery help you be more like that type of person? Tell me about what you want your life to be like. You know, what is truly important to having a rich and meaningful life, and how will recovery help you get closer to those things that are going to help you have a rich and meaningful life? So we want to help them see the purpose of this because it's hard work. We need to see that there's, you know, a really good prize, a really good carrot at the end of this stick. In the collaborative partnership between the client and counselor, each brings their own expertise. The client knows what works for them, and the client knows what doesn't work for them. We know a lot of tools. So I'm going to be constantly negotiating with the client, going, okay, so I'm hearing you've got this issue going on. What about trying this tool? And the client may say, Great. Or they may say no. That doesn't no for me. I am not a journaler. If you tell me that the best way to address a particular issue is for me to start journaling every single day, I'm going to look at you and I'm going to be honest and say, that ain't going to happen. I cannot force myself to journal. I've tried. It won't happen. And that doesn't work for me. I will do lists, I will do logs, I will do check sheets. But I'm not a journaler. So, you know, you want to negotiate that. In the collaborative partnership, we want to provide an empathic, supportive, directive style in order to maintain the conditions for change. So we want to be warm. We want to be kind of understanding what it's like to be them and how hard it is. And we want to be supportive and say, you can do this, you know, be their cheerleader, but we also may need to be a little bit directive. So think about that person in the well, you know, they're stuck down there. But then you start realizing that there are handholds there, and they're stuck, and they're tired and they're cold, and you're empathizing with them, and you're like, you know, I know how hard this is, but you can do this. So the first thing you need to do, you see that little handhold up there? You need to reach your left hand up, and you need to grab it. And you see that little handhold up there? Now reach your right hand up, just like you would give them directions on once if they were stuck on how to get unstuck. Same thing as what we need to do as counselors. And we need to direct argument and confrontation away. You know, we need to try not to argue and confront clients, because that just increases client defensiveness. We need to listen. If a client is arguing with us about something, they either feel like we're taking away their power or they feel like they're getting ready to lose something. That is their defensive nature, their protective stance. So if they're in a protective stance, if they're being defensive, argumentative, angry, that tells me they're feeling threatened in some way. So I need to back up and go, okay, let me understand a little bit more about why this makes you feel threatened. So five motivational principles. Express empathy, develop discrepancy. So if they're saying that they want to, you know, run a marathon and be in super duper tip top physical health, but they're still smoking, you Know, you want to point out that discrepancy. You have all these wonderful goals that revolve around health and wellness, yet you're still smoking. So I'm wondering how the two of those work together. Avoid argument. If the client says, you know, my smoking doesn't bother my running at all, you know, now's not the time to go. Have you lost your mind? The time to say, okay, you know, I've been wrong before. You know, I was just seemed like something to point out. Roll with resistance. When clients start becoming resistant and they don't want to do what you're telling them to do, again, that tells you that they're perceiving some sort of a threat there. So instead of, you know, it's kind of like a kid that doesn't know how to swim, he's going, I'm not jumping in that water because I'm going to drown. You don't go up and push him in and go, well, good luck. No, you say, okay, let me get in first, or let's put the floaties on or whatever. So we want to roll with resistance, and there are a lot of techniques for doing that again in tip 35. And we want to support self efficacy. That's that can do attitude and optimism. So whenever they come in, encourage the client to start the session out by telling you about three good things that happened over the past week, and, you know, what they're expecting. You know, something good that they're expecting in the next week. We want them to focus on some good things. We're going to talk about some unpleasant things in counseling, probably, but we want to make sure that they're remembering that there's also good things out there. We want them to see how far they've come. We want them to see how much progress they've made and that they've done it on their own. You know, they did it. They're efficacious, if you will. Motivational elements include partnership and a collaboration. We want to avoid the expert role. Clients are going to be a lot more motivated to do things if they're taking ownership of it. And they can say, I did that, versus that's what my therapist told me to do. We want to provide acceptance and autonomy, respecting the client's individuality and strengths. While you may think that 12 step meetings are the cat's meow, the client may not think that. So they may want to go to smart recovery or church or something else, and that's okay. We're respecting their autonomy, their right to choose and their strengths, they're finding something else to put in there. We want to provide compassion, keeping the client's best interest in mind. An evocation, which means soliciting ideas from the clients. We want to evoke the answers from them because the best ideas come from the client. Motivational techniques are designed to get at internal ambivalence and provide a place for discussion of the pros and cons of change. So we're going to evoke those thoughts from them. What thoughts are you having about why you might be afraid to change? Motivational strategies include the ORS acronym. Ask open ended questions, provide frequent affirmation, Use reflective listening when you're talking to them. Summarize what you've heard periodically, you know, don't wait till the entire end of the session. You know, stop them and go, okay, let me see if I'm following you here. Summarize a little bit and say, okay, go ahead and elicit self motivational statements. Make sure that clients are saying, I can do this or I will do this, because that implies a sense of self efficacy and a desire to continue to move forward in the process. Other motivation. Other videos you can look at on these techniques include motivational interviewing. I have several of Those on our YouTube channel, allceus.com YouTube and counseling skills, I have a couple of those on that channel as well. So we talked a lot about what counselors do today and some of the skills that you need to remember to have or that you need to remember to develop in yourself. And these are the things that are most likely to be on your certification test. So do remember the qualities and the attitudes that counselors need to have and how to develop and maintain motivation.